A Structural Toolkit for Reducing Substance-Use Stigma

A practitioner toolkit designed to reduce stigma where it is embedded in everyday practice, including intake language, service environments, onboarding, supervision, and staff responses.

At a Glance

Client: Statewide

Sector: State substance-use initiative

Format: Practitioner toolkit design

Audience: SUD Practitioners

What we noticed

Stigma remains a significant barrier to substance-use and opioid-use services. Much of it is communicated through ordinary organizational practices: the language used on intake forms, the messages conveyed by a waiting room, and the ways staff respond during difficult moments.

These structures shape a person’s experience regardless of whether any individual intends to cause harm.

Research has also shown that the terminology used in clinical documentation can affect how providers perceive the same person. In settings with significant staff turnover, attitude-focused training must be repeated continually, while changes to organizational structures can remain in place.

The intervention

A toolkit with five implementation-ready components:

  • An intake-language guide pairing stigmatizing language with affirming alternatives and ready-to-use scripts
  • A photo-based environment walkthrough completed from the perspective of a person entering services for the first time
  • A thirty-minute orientation module for new staff that does not require a train-the-trainer model
  • Pocket response cards for difficult moments, including relapse disclosure and stigmatizing language from colleagues
  • A one-page implementation guide for supervisors

The proposal also included development with four Michigan organizations representing harm reduction, treatment, and recovery in urban and rural settings. People with lived experience of substance use would participate as paid consultants throughout the process.

The toolkit would launch through a statewide virtual gallery walk in which pilot organizations shared before-and-after examples of the changes they made.

Why we designed it this way

We focused on organizational structures because stigma is produced through more than individual belief. Structural changes can also remain in place as staff enter and leave an organization.

We designed each component to be practical, affordable, and usable without ongoing outside consultation. Adoption should not depend on an organization having a large training budget or a dedicated internal facilitator.

We also designed the toolkit to be developed with people who have lived experience of substance use as paid contributors. A resource intended to reduce stigma should be shaped by the people most affected by it.

Questions for Consideration

When harm is produced through organizational structure rather than individual intention, how does that change where responsibility for addressing it belongs?

How should organizations weigh interventions that change attitudes against interventions that change conditions?

What does it mean for people most affected by a problem to hold authority in designing the response rather than only being asked for input?

SELECTED ARTIFACTS